“HIV” Prevention in Canada, Sponsored by Gilead

Has this company no shame?

Hill Times (the hill presumably referring to Parliament Hill in Ottawa, Ontario, Canada) published the following piece about the importance of PrEP, sponsored—surprise, surprise!—by Gilead Sciences, manufacturer of the very problematic medication Truvada and the culprits behind the ongoing Truvada disaster.

HIV Prevention: Time for Bold and Decisive Action

From the Introduction:

Contrary to popular belief, HIV remains a serious public health concern in Canada. New HIV diagnoses rose by a startling 25% in 2022.¹ Each week, it’s estimated that 35 Canadians are diagnosed with the condition, facing comorbidities such as mental health concerns, viral hepatitis and kidney and liver disease that negatively impact their quality of life.^{2, 3} These complications also have a significant effect on healthcare spending, with each diagnosis expected to cost an average of $1.3 million.⁴ 

The concerns over “kidney and liver disease” caught my attention because of the fact that these are not “HIV” associated conditions, but are in fact direct effects of ARVs and PrEP, as we surely know by now. The 25% increase is interesting as well, although the entire population of Canada is less than that of California, so I don’t know how significant this is. I wonder how much of this increase might be due to the massive restrictions on health care in Canada during the vaccine and lockdown craze of 2020 and 2021, leading to fewer tests earlier on. This could have had the effect of later artificially creating an “increase” that isn’t entirely real. There are a few items of interest in this piece, including this ridiculous use of language:

“Through our long-standing research initiatives, we try to understand the diverse and evolving needs of 2SLGBTQI+ people in Canada affected by HIV,” says Michael Kwag, Executive Director of CBRC.

I love the way that the acronym from the 90s, LGB or LGBT (my university’s gay club was called B-GLAD for the Bisexual, Gay and Lesbian Association of Dalhousie, about the year 2000, no TQ to be found), has done a complete disappearing act. 2SLGBTQI+?? Why is two spirit the beginning of the acronym? I find it hard to believe that “two spirit” individuals in Canada outnumber actual gays and lesbians.

It gets worse.

“With individuals facing such complex and overlapping challenges, the need for culturally informed care is critical,” says Ben Klassen, Associate Director of Research at the Community-Based Research Centre (CBRC). “Care providers must be intersectional in their approach, recognizing that people’s healthcare needs are shaped by multiple factors beyond just their sexual orientation. This means avoiding assumptions and ensuring no judgments are made during patient interactions.”

“Culturally informed care?” “Intersectional in our approach?” What does this even mean? Note the subtle condescension, which is apparent throughout.

This next quote is actually really interesting to me, having lived the first 27 years of my life (excepting the few months after my birth in Malawi & some time in the UK) in the Dominion of Canada.

While options are available to Canadians, individuals seeking care and prevention services still face many obstacles:

• Financial constraints: Currently, oral PrEP is publicly reimbursed for key populations in British Columbia, Alberta, Saskatchewan, Manitoba, the Yukon and Prince Edward Island, as well as to registered First Nation and Inuit people under the Federal Non-Insured Health Benefits Program. Other provinces offer limited coverage, which pose affordability issues for some individuals.⁶ The cost and uneven coverage for PrEP continue to hinder access to this helpful tool, regardless of modality. 

Financial constraints are actually a significant problem in Canada, because contrary to popular belief, prescription medication is not covered by the government for all or even most. (Neither are dental or vision services, but that is a topic for another day. I had no dental or prescription plan as a graduate student, for example.) The country has (limited by necessity) state run healthcare, but that is mostly limited to doctor visits and treatment for common illnesses and conditions; when it comes to prescription drug coverage, many Canadians have to pay out of pocket for their prescription, which could have serious financial implications for potential PrEP users. Truvada is $2000 a month. (Also, what “key populations?”)

Moving on. Here are the other “obstacles patients may face:”

• Geographic challenges: Those in remote and rural areas lack convenient access to HIV services while the extremely high demand in urban centres strains the system, making it hard for individuals to access effective and safe care.⁷

• Information gaps: Some communities don’t have access to the right information and remain unengaged in prevention care, resulting in the inequitable distribution and uptake of these tools and services.

The “geographic challenges” are also related to the “financial constraints” listed above, because they are both at least partly because of how health care is managed at the federal level. Due to the nature of the medical system in Canada, there is little incentive for doctors and nurses to take positions in rural areas, so the more sophisticated medical centers are located only in the largest cities, creating clear “barriers to access” for rural patients, of which there are many, not to mention the strain on the urban centers. The “information gaps” section seems a bit condescending to me, like the rest of this article.

Let’s see what their actual solution is. Oh, what a surprise—more testing! And PrEP for everyone! You get PrEP, you get PrEP, and you get PrEP, everyone gets PrEP! (Emphasis is mine.)

Part of CBRC’s work involves identifying structural gaps for strengthening prevention efforts with affected communities, today and into the future. Increased testing and enabling more consistent engagement throughout the care continuum remain top priorities for HIV in Canada. Their research also suggests that new medical interventions like long-acting PrEP present an opportunity to reach individuals who have not engaged with other modalities, increasing overall PrEP uptake. 

And of course, “marginalized communities” are right in the bullseye for “retention in care.” Convince me that the HIV AIDS story isn’t, at its core, racist and anti-gay. I’m not holding my breath.

The Government of Canada recognizes the importance of ending this epidemic and has made strides to address it, specifically within marginalized communities. The 2020-2022 progress report on Canada’s Action Plan on Sexually Transmitted and Blood-Borne Infections (STBBIs) highlights significant progress, including a temporary $17.9 million funding initiative to improve access to HIV testing with a focus on marginalized communities, and support for the 24th International AIDS Conference. The government also focused on addressing STBBIs in Indigenous communities, enhancing culturally safe health services, and increasing community-based health initiatives. These efforts aim to reduce STBBI rates and improve public health outcomes.

Canadians are really going for the gold with the confusing acronyms in this story. First we had the two spirit one, and now the old reliable term STI isn’t clear enough? We need two more letters that convey what information, exactly? I’m just being pedantic here, but it’s annoying and I have to wonder if it’s intentionally confusing. Another possibility is that this acronym is implicitly acknowledging the fact that, even per mainstream sources, “HIV” is not a true STI; the official narrative is that it must “enter through the bloodstream.” (If there is even an “it” to consider here; see this post for my views on the “existence” question.)

This next clip is actually creepy:

Community leaders like CBRC advocate for this type of commitment to continue. Government leaders must remain focused on monitoring PrEP use to enable data-driven decisions. Ultimately, we must reduce barriers to HIV prevention regimens, along with treatment and support services, for priority populations.

Monitoring PrEP Use? With a wearable tracker, perhaps? What’s next, a PrEP snitch line? It is Canada, so anything is possible. And don’t get me started on “priority populations,” code for “victims.” The article draws to a close, with the following footnote:

This story was made possible with support from Gilead Sciences, Canada Inc.

Of course it was. It’s really interesting to me the public relations blitz that is currently happening with Gilead in an attempt to memory hole the continuing massive lawsuits they are engaged in regarding Truvada. Gilead must have paid a pretty penny, in advertising dollars or some other way, for this story to be possible. And then we have the flurry of excited reports on the lenacapavir (lots of information at this link) long acting injectable “no seroconversions” phase one trials, made possible by Gilead, of course, and whose results will surely fizzle out, as has happened with every “miracle” drug brought to market that later turns out not to be so miraculous. And given the complete media dearth of information regarding these lawsuits, there is every possibility Gilead might succeed.

This will not, however, stop me from continuing to remind the public of the disturbing side effects of these drugs and of the coordinated attempt among the media and the AIDS activists to make this story go away. It isn’t leaving the courts anytime soon, and I can only hope that Gilead is held to account and is hit where it hurts the most—their bottom line.